Patients seeking appointments should call the psychiatry intake line at 617-724-7792. You must say that you would like your name to be placed on the CBT wait list.
Cognitive-Behavior Therapy (CBT) is used with a broad spectrum of psychiatric disorders and medical issues, ranging from disorders such as anxiety disorders, obsessive-compulsive disorder, depression, or schizophrenia, to pain and insomnia.
CBT consists of two components: Cognitive Strategies and Behavioral Interventions.
-- Cognitive Strategies: The therapist and patient work together to identify how certain distorted patterns of thinking are related to the patient’s symptoms. The therapist then attempts to help the patient evaluate and modify his or her self-defeating thoughts and beliefs.
-- Behavioral Interventions:
Behavioral interventions are derived from learning theory and are used to alter a person’s maladaptive behaviors. Behavioral interventions help to lessen the associations between an individual’s disturbing concerns and his or her maladaptive responses to them. Behavioral techniques include: exposure; ritual prevention; assertiveness training; the scheduling of pleasant activities so as to improve mood, relationships, and general, overall functioning; problem solving; and motivational strategies.
- Exposure: Patients will learn to confront situations they usually avoid (e.g., a public bathroom for a patient who fears being contaminated; a dog for a patient who is afraid of dogs). This is usually done in a gradual fashion, moving from less anxiety-provoking situations to more challenging ones at a rate with which the patient feels comfortable. Following such exposures, a previously disturbing and unpleasant encounter will likely become significantly more tolerable.
- Ritual Prevention: The prevention of ritualistic behaviors (e.g., checking, compulsive hand washing, comparing oneself to others). It is expected that anxiety or discomfort will decrease (i.e., that the patient will “habituate”) during exposure and ritual prevention exercises.
- Assertiveness Training: Is intended to teach people various strategies for recognizing and acting upon their wants, needs, and views while still being respectful and appropriate towards others. Assertive training typically involves role-plays in which participants practice clearer and more direct forms of communicating with others. An improvement in communication can often significantly impact one’s relationships, career opportunities, etc.
- Activity Scheduling: The planning of enjoyable events and achievement-oriented activities.
- Problem Solving: Involves specifying a problem, creating solutions, selecting a specific solution, and implementing it. Finally, the effectiveness of the solution is evaluated. If the result is not satisfactory, another solution is selected.
- Motivational Strategies: Are used to increase commitment to change and boost motivation.
CBT is very structured and goal-oriented and requires a joint effort between the therapist and patient. Development of a collaborative relationship between the therapist and patient is key. This means that both the patient and therapist must take an active role in understanding the patient’s issues, identifying the goals aiming to be accomplished through treatment, and working to reach these goals. A CBT therapist will begin by conducting a detailed assessment of problems and symptoms and will also determine what the patient is hoping to gain in treatment. The two then work together to develop a personal, individualized, treatment plan with those goals in mind. A specific agenda is set for every session, with various techniques and concepts taught during each one.
To obtain significant improvement with CBT, motivation is vital, as it requires a great deal of commitment and effort on the part of both the patient and therapist. It is important for the patient to give feedback, both positive and negative, at each therapy session. This allows the therapist to alter the speed, style, and content of future sessions in order to meet the specific needs of the individual patient. Patients will be given many “homework” assignments to complete outside of the therapy sessions. These tasks are assigned to reinforce what skills are learned during therapy sessions. While receiving CBT requires a great deal of work and devotion, the outcome can be extraordinary.